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HEALTH

Americans in France: What’s the deal with health insurance?

Americans moving to France often have many questions about the healthcare system in France, what type of cover they need and what they should expect to pay.

A doctor at a hospital talks to a patient who is lying on a bed at a hospital in southern France.
Photo: Nicolas Tucat / AFP

If you’re moving to France to live, it’s likely that you will need a visa and this may come with requirements concerning health cover.

But once you have been living in France for a certain period of time you’re entitled to register within the French system for state healthcare, so it’s really a two-step process regarding your health cover.

If you’re only visiting – whether as a tourist or someone with a visitor visa – the system is different 

Health insurance in France: What are the requirements for visitors and residents?

Importantly, paying for private health insurance does not necessarily give you quicker or better access to medical treatment in France.

Healthcare here is routinely and universally excellent.

The first three months

For most types of visa to stay in France, holders will be required to demonstrate an ability to cover the cost of any healthcare. 

This usually means having some form of private insurance to cover the costs of medical repatriation, and emergency and/or hospital treatment to a minimum amount – usually €30,000 – for the length of any stay.

Obviously, this insurance needs to extend cover to France. It is important to note that an American health insurance card is not proof of adequate coverage.

After three months

Anyone who has lived in France for three months and established residency, is eligible to register within the French state health system. 

For this, you will need a numero de securité sociale and a carte vitale – you can apply for this at the Assurance Maladie website www.ameli.fr

READ ALSO How to get a carte vitale

Once you are registered in the French system, you can then cancel your private health insurance policy – visas only require that you have health cover, and that can include cover from the French system.

However getting yourself registered can take some time – up to six months is common – so we would suggest you don’t cancel the insurance until you are registered and have your carte vitale, just in case.

How the French system works

The French state health system is an insurance system – it’s known as Assurance maladie (health insurance) – and the basic premise is that for any medical cost  (a doctor’s appointment, a prescription, a medical procedure) you pay upfront and the government then reimburses you with part or all of the cost.

The green-and-yellow credit card-sized card known as a carte vitale is proof that you are registered in the French healthcare system. 

Guard your magic healthcare card well. Photo by DENIS CHARLET / AFP

Its microchip contains details of your rights to health cover, and will be routinely requested by your doctor, pharmacist, dentist etc. 

It guarantees that the State will repay its share of your healthcare costs – which can be anything from 30 percent to 100 percent of the total costs depending on your circumstances.

Once you have paid the health professional, they then swipe your carte vitale and the money goes straight into your bank account within a couple of days – there is no need for you to take further action.

Retirees

If you’re working in France then you’re paying taxes and in exchange the French state will pay your healthcare costs.

If you’re receiving a pension from another country, then usually the French state will pay your costs but then reclaim them from your home country if there is a bilateral agreement in place.

If you’re not working and have not yet reached pension age, you can register for French healthcare through the PUMa system.

But however your healthcare is paid for, you simply swipe the carte vitale and get the money back in your bank account.

‘Top-up’ health cover

As mentioned above, the state system only reimburses a percentage of your costs.

How much is reimbursed is complicated and depends on the type of appointment, type of medical condition being treated and your personal circumstances (eg if you’re pregnant, on benefits or a war veteran).

For example, a standard visit to your family doctor (médecine traitant) costs €25 and is reimbursed at 70 percent, so you get €16.50 back.

Certain conditions, such as cancer or endometriosis, have 100 percent reimbursement where all your costs are taken care of, while others have a rate of 70 or 80 percent reimbursement.

There are a lot of exceptions however and it’s all quite complicated – full details HERE.

In order to cover the extra bit, 96 percent of French people have ‘top-up’ cover, known as a mutuelle.

This takes care of all the extra costs and depending on the policy also covers things like spectacles, hearing aids and dental prothesis or cosmetic treatments.

The first thing you will notice about a mutuelle is that they are considerably cheaper than US private health insurance.

The average cost is about €40 per month for a single person, rising to about €110 for a family of four. If you are an employee, your employer is legally obliged to pay at least half of the cost of your mutuelle.

READ ALSO What you need to know about a French mutuelle

Private insurance

There is no obligation to be registered in the French state system and you can continue to pay for private health insurance if you want.

It doesn’t really give you much of an advantage, though, as French state healthcare is of a very high standard. If you do decide to do this, you will notice that the costs for medical treatments, drugs etc are a lot lower than you are used to back in the US.

It can be helpful to be registered in the state system so that you will routinely be included in public healthcare campaigns. Once you have your details registered you will then be invited for relevant appointments, for example for pap smears or the flu vaccine, depending on your health needs.

It is possible to be registered in the state system and continue to pay for private health insurance if you want.

Member comments

  1. Thanks for this. But in case we opt to keep the private health insurance after 3 months, what insurance companies are recommended? Are there folks that keep their private insurance for the long term and what companies do they suggest?
    It may be interesting to read this as a topic too. Thx.

  2. We are registered, my husband has received his carte vitale. I have not, but I did get an attestation de droits à l’assurance maladie. Do I have to submit something to get reimbursed as described in this article or will it be automatic?

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TRAVEL NEWS

Covid rules: Travelling abroad from France this summer

There's been plenty written on travel rules for people coming to France - but what if you live in France and have plans for international travel over the coming months? We've got you covered.

Covid rules: Travelling abroad from France this summer

France isn’t currently on the Covid red list for any country, so there is nowhere that is barred to you as a French resident, but different countries still have different entry requirements.

EU/Schengen zone

If you’re travelling to a country that is within the EU or Schengen zone then it’s pretty straightforward.

If you’re fully vaccinated then all you need is proof of vaccination at the border – no need for Covid tests or extra paperwork. Bear in mind, however, that if your second dose was more than nine months ago you will need a booster shot in order to still be considered ‘fully vaccinated’. 

READ ALSO Everything you need to know about travel to France from within the EU

If you were vaccinated in France then you will have a QR code compatible with all EU/Schengen border systems. If you were vaccinated elsewhere, however, your home country’s vaccination certificate will still be accepted.

If you’re not fully vaccinated you will need to show a negative Covid test at the border, check the individual country for requirements on how recent the test needs to be.

Bear in mind also that several EU countries still have mask/health pass rules in place and some countries specify the type of mask required, for example an FFP2 mask rather than the surgical mask more common in France. Check the rules of the country that you are travelling to in advance.

If you’re travelling to a country covered by The Local, you can find all the latest Covid rules in English on the homepages for Austria, Denmark, Germany, Italy, Norway, Spain, Sweden or Switzerland.

UK

The UK has no Covid-related travel rules, so there is no requirement for tests even if you are not vaccinated. The passenger locator form has also been scrapped – full details HERE.

Once there, there are no Covid-related health rules in place. 

If you’re travelling between France and the UK, remember the extra restrictions in place since Brexit.

USA 

Unlike the EU, the USA still has a testing requirement in place, vaccinated or not. You would need to show this prior to departure.

It has, however, lifted the restrictions on non citizens entering, so travel to the USA for tourism and visiting friends/family is once again possible.

For full details on the rules, click HERE.

Once there, most places have lifted Covid-related rules such as mask requirements, but health rules are decided by each State, rather than on a national level, so check in advance with the area you are visiting.

Other non-EU countries

Most non-EU countries have also lifted the majority of their Covid related rules, but in certain countries restrictions remain, such as in New Zealand which is reopening its border in stages and at present only accepts certain groups.

Other countries also have domestic Covid restrictions in place, particularly in China which has recently imposed a strict local lockdown after a spike in cases.

Returning to France

Once your trip is completed you will need to re-enter France and the border rules are the same whether you live here or not.

If you’re fully vaccinated you simply need to show your vaccination certificate (plus obviously passport and residency card/visa if applicable) at the border.

If you’re not vaccinated you will need to get a Covid test before you return and present the negative result at the border – the test must be either a PCR test taken within the previous 72 hours or an antigen test taken within the previous 48 hours. Home-test kits are not accepted.

If you’re returning from an ‘orange list’ country and you’re not vaccinated you will need to provide proof of your ‘essential reasons’ to travel – simply being a resident is classed as an essential reason, so you can show your carte de séjour residency card, visa or EU passport at the border.

Even if the country that you are in is reclassified as red or orange while you are away, you will still be allowed back if you are a French resident. If you’re not a French passport-holder, it’s a good idea to take with you proof of your residency in France, just in case.

Fully vaccinated

France counts as ‘fully vaccinated’ those who:

  • Are vaccinated with an EMA-approved vaccine (Pfizer, Moderna, AstraZeneca or Johnson & Johnson)
  • Are 7 days after their final dose, or 28 days in the case of the single-dose Johnson & Johnson vaccines
  • Have had a booster shot if more than 9 months has passed since the final dose of your vaccine. If you have had a booster shot there is no need for a second one, even if more than 9 months has passed since your booster
  • Mixed dose vaccines (eg one Pfizer and one Moderna) are accepted 
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